Does anybody have a better resolution of the article?
Here you go! Word for word. Identical to the newspaper scan.
Tinnitus, the buzzing that never goes away
One in ten people has tinnitus. It's incurable, but you can tune out the sound, the experts say
Tinnitus is often one-sided, more commonly in the left ear, for unknown reasons
After a six-hour operation to remove a large benign brain tumour last week, the former BBC correspondent Rosie Millard cited "a bit of tinnitus on one side" as the symptom that led to its discovery. Tinnitus, the perception of noises in the head or ear that have no external source, affects six million people in the UK. However, says Dr Laurence McKenna, a consultant clinical psychologist of the Royal National Throat, Nose and Ear Hospital, UCLH, the chance of a benign brain tumour being the cause — there's no known association to malign tumours — is about 1 in 10,000. "It really is very, very rare."
Rosie Millard after her six-hour operation
Tinnitus, however, is common. "It is one of the most prevalent physical symptoms to affect humanity," McKenna says. The sensation may be constant, intermittent, vary in volume and present as a ringing, buzzing, hissing, whistling or other noise. It's often one-sided, more commonly in the left ear, for unknown reasons. It can be prompted by anything that causes a change within the auditory pathway — for instance, damage to the tiny hair cells in the cochlea (normally, sound vibrations cause these hairs to move, creating the nerve signals the brain understands as sound). Noise trauma or continuing noise exposure are often factors and usually tinnitus is a consequence of hearing loss. Frequently, it's hearing loss in the high frequency range. The brain tries to compensate for this loss by generating the tinnitus.
"It can also be brought on by a really bad cold or flu that goes to your ears, wear and tear, another infection," McKenna says. It's more common as we age, although his colleagues in paediatrics see children as young as five with tinnitus.
Dr William Sedley, of Newcastle University's Institute of Neuroscience and a spokesman for the British Tinnitus Association (BTA), says: "There are so many young people with a little bit of noise-induced hearing loss from clubs and bars or listening to their iPhones too loud. That's enough to do it." Tinnitus can also be triggered by stress.
Sufferers of a very rare form of dementia experience a slightly higher rate of tinnitus than the general population, but Sedley says: "It's such a small niche association. For someone who's got tinnitus, their chance of developing dementia isn't significantly higher than anyone else's. For most people it's a benign condition — it doesn't represent anything more sinister." There is, however, no cure. "A lot of researchers are working on trying to take the sound away, but we're a way off from that still."
Indeed, for the vast majority effective treatment consists of reassurance, knowing that eventually your brain will tune out your tinnitus. "Initially it's new, potentially threatening," Sedley says. "After a while, when it's listened to it for ages and nothing's come of it, the brain gets bored and assigns it to the background. People realise they've gone huge, long periods of time without noticing it."
For most of those with tinnitus the advice is to cover the basics: get your hearing checked, ensure there isn't wax obstructing your ears and try a hearing aid. "A hearing aid restores some of the lost hearing," Sedley says, "and that does help reduce the tinnitus for a lot of people." Other factors such as anxiety, insomnia and depression should be treated because they all make tinnitus much harder to cope with.
Those who aren't agitated by tinnitus often mask it by avoiding quiet environments and — when they need quiet, at work or bedtime — by listening to relaxing music, white noise or soothing sounds. Sedley says: "Because tinnitus is caused by hearing loss — the loss of your brain being stimulated by sound — the more sound you add in, the more it suppresses the tinnitus and gives you something else to focus on. You can get sound pillows with a built-in speaker. They help in the immediate sense, and gaining that sense of control can be an important psychological benefit."
The experience of tinnitus is a fairly intricate weave between physical and psychological processes, McKenna says, and for one in ten of the six million sufferers the condition is torture. That's 1 per cent of the population, he says, "an awful lot of people. They fear if they start hearing it, they'll never be able to not hear it, and as a consequence might lose their sanity. They constantly distract themselves, obscure it using external noises. That's physically and emotionally exhausting, and maintains the anxiety. Being on the run from tinnitus doesn't help. It gets in the way of the natural process of habituation."
There's no magic pill, but scientific evidence shows psychological intervention such as cognitive behavioural therapy (CBT) is highly effective. McKenna says: "When the noise is going to stop me concentrating, interfere with my relationship with my children, stop me sleeping, it has a strong emotional significance. CBT addresses that high level of arousal and emotional significance. It tests those assumptions." In reducing fears, it helps to undo sufferers' perpetual "middle-of-the-night thinking" and their experience of tinnitus becomes less distressing.
Mindfulness-based cognitive therapy (MCBT) is the latest development within CBT. "It uses meditation exercises as a scaffolding for delivering some of these psychological ideas," McKenna says. "It encourages people to stop fighting it quite so much."
His clinic offers a programme of MCBT, which follows his two-year trial with Dr Elizabeth Marks of UCLH and the University of Bath to investigate its effectiveness compared with relaxation exercises (eg progressive muscle relaxation, visualisation), an established approach to managing tinnitus. "Both treatments produced statistically and clinically significant changes in people's experiences," he says, "but the mindfulness produced significantly more benefit than the relaxation exercises."
Vagus nerve stimulation (already used for epilepsy) has a moderate effect on reducing the volume of tinnitus. It is likely to be available at some private clinics next year and may interest those who aren't squeamish and have more than £15,000 to spare, Sedley says. "An implant is placed in your neck, a little electrode, around the vagus nerve [which has a calming role in our flight-or-fight system], which is connected to a pacemaker-style battery under the skin by your collarbone. It plays sounds in your ear that are a bit like the tinnitus for a certain amount of time every day, while stimulating the vagus nerve, and that relaxes everything. It can break up connections in the brain that cause the tinnitus."
Meanwhile, a promising and less expensive treatment is on the horizon, which Professor Berthold Langguth, the director of the Tinnitus Centre in Regensburg, Germany, spoke about last week at the BTA's annual conference in Birmingham. We hear, he says, when sound waves enter the inner ear as vibrations and are transformed into electrical signals, transported along the auditory nerve to the brain, where they are further processed and understood as sound.
However, "the nerves which come from the face and neck area connect with the nerves that come from the ear and also influence the processing of the signals that come from the ear. We have this connection so that when we hear a sound we can detect exactly where it's coming from." Therefore, "the brain also needs information on the position of the face and the head in relation to the body".
The new treatment takes advantage of this connection. Patients listen to sounds through earphones for an hour daily, while their tongue tip is gently electrically stimulated by a small toothbrush-like device (producing a light tingling sensation). "This signal which goes to the tongue connects in the brain and bypasses the damaged cochlea," Langguth says. "Normally because of the hearing loss the sound does not get completely to the central nervous system, but when presented at the same time as the electrical signal, the nerve fibres from the tongue connect with the nerve fibres from the ear to bring the information to the brain. By using this approach we were able to reduce the amount of tinnitus suffering in patients."
After 12 weeks of treatment an impressive 80 per cent of 500 patients experienced a lasting improvement. "To be honest the results are a bit better than expected," Langguth says. Indeed, they're so promising that the device may be approved in Europe for treatment next year, although he stresses that they offer an improvement, not a cure.
Dr Raj Shekhawat, a clinical audiologist from New Zealand, of the Tinnitus Research Initiative, also spoke at the BTA conference about his promising clinical research into "brain stimulation". He says: "In people with tinnitus there is some form of hearing damage in the hair cells in the inner ear. As a result of that damage the cells create an error signal perceived by the brain as tinnitus. There's no sound, but the brain perceives it as a sound. And the moment you hear that sound — 'Hang on, there's no sound source, the alarm is OK, the TV's fine, but I'm still hearing the ringing' — the emotional area is alerted: 'Am I going crazy, have I got a tumour, am I going to lose my hearing? Nobody else is hearing it.' "
Brain stimulation alone can result in temporary suppression of tinnitus in some patients, Shekhawat says, "which is fabulous, a ray of hope". This involves delivering a mild electric current to the auditory cortex and the prefrontal cortex using small electrodes placed on the head. "The auditory area is involved in perception of the sounds and processing the features of sound, and the pre-frontal cortex is the emotional centre," he explains. "This area in the brain is constantly firing, firing, firing, thinking there's some sound, and there's emotional distress to it. We are trying to calm it down a little bit."
Shekhawat is trying to extend the effects of the treatment. "Our latest study shows stimulating the brain for six sessions every two or three days is more effective than one session or back-to-back sessions." Shekhawat says that this treatment is exploratory, a research tool, not a clinical tool. "But," he says, "the field of tinnitus is such that we must come up with crazy, innovative ideas."